What you need to know now about pregnancy-related depression

Are down days and crying jags a normal part of new motherhood—or signs of a serious health concern?

Are there legitimate alternatives to medication? Or are vitamins, as Tom Cruise infamously suggested, the only option for women who are wary of taking antidepressants while breastfeeding or carrying a child?

Here’s what the experts say you really need to know about depression and pregnancy.

Diagnosis

Depression during pregnancy. “Women of childbearing age are naturally more vulnerable to depression than anyone else,” affirms Shaila Kulkarni Misri, MD, founder and director of Reproductive Mental Health at BC Women’s Hospital & Health Centre in Vancouver. While some women believe that pregnancy will lift their mood, it often does just the opposite. Misri points out that shifting hormones combined with the mental and emotional stress of pregnancy can trigger an episode of depression in women who are susceptible to it because of genetic and/or social factors. In fact, a full 8.5 to 11 percent of women suffer from depression while carrying a child, according to the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services.

Are you suffering? If you’re clinically depressed, have had a bout of depression in the past, or have a family history of mental illness, discuss it with your doctor as soon as you find out that you’re pregnant. This way, she can be on the alert for symptoms while you’re expecting your baby. According to the AHRQ, depression in pregnancy often goes unnoticed because some symptoms —fatigue, nausea, frequent napping, and mood and appetite changes—are common in normal pregnancies, too. “If you experience deep, relentless sadness for more than two weeks at any point during your pregnancy, these are not normal feelings,” explains Misri, author of Pregnancy Blues: What Every Woman Needs to Know about Depression During Pregnancy.

Postpartum depression. The AHRQ notes that postpartum, between 50 and 85 percent of new moms experience the “baby blues,” characterized by fatigue, mood swings, and crying spells. These symptoms are a normal reaction to the hormone changes and exhaustion of caring for a new baby, and normally go away within a week. In fact, only up to 13 percent of women experience true postpartum depression (PPD), which is diagnosed if the blues continue for longer than two weeks, and can develop anytime within the baby’s first year, the National Women’s Health Information Center reports.

Are you suffering? Postpartum symptoms can be sneaky, too. All mothers are tired after giving birth, but if your fatigue doesn’t fade, it can be an early sign of PPD, a 2005 Ohio State University study notes. Women who still felt extremely fatigued two weeks after having a baby were more likely to suffer from PPD a month after giving birth, the researchers discovered.

Prevention

Plan ahead. Here’s some good news: If you’re at extra risk for depression, you may be able to prevent PPD by arranging ahead of time for extra help. In a University of Toronto study published in 2005, researchers found that new mothers who received individual support from a health professional (a doctor, nurse, or midwife) were less likely to develop PPD.

“In cultures where there is little depression in mothers, moms are supported in the weeks after they have their babies,” says health psychologist Kathleen Kendall-Tackett, PhD, clinical associate professor of pediatrics at Texas Tech University School of Medicine. “Ask your friends and family for help with dinner, grocery shopping, or household chores, and make sure visitors respect your need for rest,” she says.

Get some sleep. Researchers found that those with PPD took longer to fall asleep and slept for shorter periods. Moreover, their sleep quality worsened as their PPD symptoms became more severe. Sleep deprivation can make it difficult for a mom to care for her new baby, as judgment and concentration decline when sleep becomes impossible. Sleep-deprived moms can inadvertently compromise their infants’ sleep quality, too, as infants tend to adopt their mothers’ circadian sleep rhythms. It’s practically impossible for a new mother to survive the postpartum period without losing sleep, as her estrogen and progesterone hormone levels plunge post-birth.

According to one recent study, new moms spend an average of 20 percent more time awake during the first six weeks after giving birth, plus they wake more frequently and have less REM (dream) sleep, with women in their first month postpartum spending only 81 percent of their time in bed actually sleeping. Neurotransmitters that influence sleep quality also affect mood, raising sleep-deprived mothers’ risk for depression. Don’t underestimate the importance of sleep. Fight the blues by sleeping whenever your baby sleeps (yes, the dishes can wait!), insisting on a few minutes of “me time” (sans baby) every day, and leaning on loved ones for support.

Watch your hormones. For years, experts and non-experts alike believed that pregnancy hormones provided a buffer against depression. Now we know that the rapid increase in hormone levels at the beginning of a woman’s pregnancy can interfere with her brain chemistry, leading to both anxiety and depression. Fortunately, hope may be on the horizon, as studies in animals suggest the possibility of a drug that may help. When UCLA researchers used genetically engineered mice unable to adapt to sex hormone fluctuations during and after pregnancy, evidence suggested which hormones were in charge of affecting a woman’s mood post-delivery.

After giving birth, these genetically altered mouse mothers acted similarly to those of women with PPD. (Women may be more vulnerable to PPD after they’ve given birth and their hormone levels radically dropped.) Interestingly, the animals’ behavior reversed after researchers provided a drug that restored their ability to adapt to hormone fluctuations. The good news? Researchers believe that this strategy may someday help develop new treatments for PPD.

Treatment

Try counseling. Cognitive therapy can be a big help in treating moderate to severe depression. Researchers from the University of Pennsylvania and Vanderbilt University found that 58 percent of moderately to severely depressed patients responded to therapy; exactly the same number were treated successfully with antidepressants. Therapy patients, however, were less likely to relapse over the next two years, perhaps because they learned strategies to manage their problems and emotions.
Calm your fears. Several recent studies have examined the effect of antidepressant medications on unborn babies. At first glance, the results seem frightening. What matters, though, is that most of the risks researchers found were rare. Moreover, in most cases the risks of not being treated for depression far outweigh the risks of taking the drugs, according to Misri. “More than half of U.S. pregnancies are unplanned, so fetal exposure to medication, including antidepressants, is bound to occur before a woman even realizes she’s pregnant,” Misri says. “As for the effect of antidepressants on breastfeeding, experts now believe that most [with the exception of MAOIs (monoamine oxidase inhibitors) like Nardil and Parnate] are safe to use while breastfeeding,” says Kendall-Tackett, who wrote The Hidden Feelings of Motherhood: Coping With Mothering Stress, Depression, and Burnout. “Studies suggest that their transfer into human milk is moderate, if not imperceptible.” Play it safe, however, and use the lowest dose that works for you, she recommends.

Risks of depression during pregnancy. Women who stop their meds during pregnancy are five times more likely to experience a recurrence of depression than women who continue taking them throughout their pregnancy, researchers at Massachusetts General Hospital report. “Because the risk of relapse is so high, trying to prevent your unborn baby from being exposed to antidepressants can backfire,” says Lee S. Cohen, MD, director of the Perinatal and Reproductive Clinical Research Program at Massachusetts General Hospital, and the study’s lead author. “In the end, you can inadvertently expose your baby to both the risks of depression in utero, and to the effects of the antidepressants that you end up using after all to treat the relapse,” he says.

Depression during pregnancy can set you up for PPD, too. In one Swedish study, 45 percent of subjects who were depressed after childbirth were found to have exhibited similar symptoms during their pregnancies. Furthermore, women with undiagnosed depression often self-medicate with alcohol or drugs, leading to potential health problems like birth defects and Fetal Alcohol Syndrome, the leading preventable cause of mental retardation. Plus, depression may be associated with an increased risk for preeclampsia, a type of hypertension that can be fatal to both mother and child, a Finnish study reports.

Alternative Therapy

Exercise your options. If your depression is minor, one of the following alternatives may be enough to get you feeling well again—or they can be practiced alongside medication if your symptoms are moderate to severe. Be sure to consult your doctor to find the treatment that’s right for you, however, and never go off antidepressants without his or her approval. There can be serious withdrawal effects if you don’t come off the medication correctly.

BRIGHT LIGHT—Light therapy may be just as effective as antidepressants in reducing the symptoms of depression during pregnancy, a 2004 study from Yale University reports. Similar studies have found bright-light therapy helps alleviate symptoms of PPD during the fall and winter months. Light therapy is easy to use; you don’t even have to leave the house to get it. All it involves is sitting in front of the light box for 30 minutes to an hour in the morning while you read or work.

EXERCISE—A 2005 study from the University of Texas Southwestern Medical Center suggests that exercise is a powerful way to combat the symptoms of mild to moderate depression. Results showed an almost 50 percent reduction in depressive symptoms among those who exercised for 30 minutes at least three times per week. Try walking, dancing, or swimming—all are safe for pregnant women.

MASSAGE—A good massage can be more than just relaxing, a study from the University of Miami School of Medicine and Duke University Medical School reports. Researchers found that massage therapy helped reduce depressed pregnant women’s stressful mood states, as well as lessening complications both during and after labor. And the therapy was simple and cost-effective, involving two 20-minute massages per week given by the woman’s significant other. Try it yourself with Mother Massage: A Handbook for Relieving the Discomforts of Pregnancy by Elaine Stillerman, LMT, or visit www.mothermassage.net/ registry.php for a list of therapists trained in Stillerman’s techniques.

OMEGA-3 FATTY ACIDS—Upping your intake of omega-3 fatty acids may be just what your body needs to relieve your depression. Studies have found that individuals who eat less fish are much more likely to suffer from PPD, perhaps because a high percentage of the omega-3s a woman takes in during pregnancy and while breastfeeding are diverted to her baby. Get your quota from oily fish such as salmon, cod, or tuna (choose “light” canned over “white” canned to keep mercury levels low), or in supplement form. “Aim for 200 mg of DHA (docosahexaenoic acid) per day,” says Kendall-Tackett. (Check the label to make sure they’ve been tested for contaminants like mercury and other neurotoxins, or visit www.ConsumerLab.com for names of reputable companies.) You can also get your omega-3s from DHA-fortified eggs.

Don’t give up

“The lack of self-confidence that is a hallmark of depression can lead women to believe that they may fail in their role as a mother, an anxiety that can lead to the very problems they fear,” says Misri. Bonding with your newborn is especially likely to be affected. “When moms are depressed, they become less adept at reading their babies’ cues,” Kendall-Tackett points out. “They tend to either withdraw from their babies or respond to them with anger.”

Remember: A happy mom is a better mom. It’s always better to admit that you’re depressed and find help than to ignore your symptoms and potentially damage your child. “It’s hard for someone who’s depressed to ask for help,” states Misri. “There’s still a sense of stigma and shame attached to depression. Despite how far people have come, the majority still see the disorder not as an illness like meningitis or cancer, but as a state of mind that a depressed person should be able to deal with on their own.

Celebrities who have experienced PPD

Here are five stars who weren’t afraid to share their experiences with postpartum depression (PPD) and the baby blues.

Brooke Shields. Developed PPD after the birth of her daughter, Rowan, in 2003—an experience she chronicles in her book, Down Came the Rain: My Journey Through Postpartum Depression. “I attributed feelings of doom to simple fatigue and figured that they would eventually go away. But they didn’t; in fact, they got worse,” Brooke wrote in a New York Times op-ed piece.

What helped: “[Antidepressants], along with weekly therapy sessions, are what saved me,” she has said.

Carnie Wilson. The singer experienced a mild case of PPD after the birth of her daughter, Lola, in 2005. “I cried over everything,” she has said.

What helped: Hypnosis tapes and exercise.
Kate Hudson. Suffered a mild case of the blues after her son, Ryder, was born in 2004. “It wasn’t a very intense depression,” she has said, “but I had a phase.”
What helped: Since Kate’s experience wasn’t true PPD, but the more common baby blues, her symptoms would have subsided naturally.

Marie Osmond. Wrote Behind the Smile: My Journey Out of Postpartum Depression about her struggles with PPD after the birth of her son, Matthew, in 1999.

Courteney Cox-Arquette. “I went through a really hard time—not right after the baby, but when Coco [born 2004] turned 6 months,” she said. “I couldn’t sleep. My heart was racing. And I got really depressed.” She also dealt with suicidal urges, such as driving off a cliff.

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HEALTHY HABITS

Most of us don’t default to healthy habits. It takes planning and effort, and sometimes a surge of self-discipline, to eat right, exercise, get the sleep we need, and stay on top of work and life tasks. Establishing new habits, let alone purging bad ones, can require major effort, especially if we are also struggling with depression or anxiety. What are some good habits that you've formed and how did you build them?